Outpatient commitment extension bill AB 2357 to be heard in Senate Appropriations June 26

Involuntary outpatient commitment extension bill AB 2357 (Karnette and Yee) will be heard in the State Senate Appropriations Committee on Monday, June 26, at 1:30 PM in Room 4203 of the State Capitol Building in Sacramento.

The California Network of Mental Health Clients (CNMHC) and representatives of other agencies in the Coalition Advocating for Rights, Empowerment and Services (CARES) will be there to speak in opposition the bill. California Network members, mental health clients, survivors and allies are encouraged to attend the hearing and to write letters to Appropriations Chair Kevin Murray (D-Los Angeles) and other committee members. To download the CNMHC's open letter to Senator Murray, click here. For more information on ways to get involved, visit the CNMHC Bay Area Region Action Alerts section.

As amended April 4 in the Assembly Health Committee, the bill would extend the sunset date of AB 1421 ("Laura's Law") by five years (to 2013) and require the California Department of Mental Health (httpDMH) to submit a report and evaluation of each AB 1421/2357 program implemented in whole or in part to the governor and the legislature by 2011. As AB 2357 made its way through first the Assembly and then the Senate, the bill's authors, Assemblymembers Karnette (D-Long Beach) and Yee (D-San Francisco) have picked up nine nominal co-authors over the past two months in both chambers, including one Republican co-author in the Assembly and another, Samuel Aanestad (R-Nevada City), in the Senate.

Recent history.

In AB 2357's first and most recent State Senate committee hearing on June 14, the bill was passed out of the Health Committee by a narrow margin of 5-3 following a heated and contentious discussion.

Ortiz uncovers the truth.

During the emotionally charged hearing, Health Chair Deborah Ortiz (D-Citrus Heights) asked the bill's proponents and opponents for clarification on the matter of whether any county had in fact implemented AB 1421.

In his statement in support of AB 2357, California Psychiatric Association lobbyist Randall Hagar claimed that Los Angeles County had implemented Laura's Law in a small pilot program, that case managers in the county had reported great success with the program, and that other counties, including Sacramento, San Francisco, and Nevada Counties, were intent on implementing the law. Hagar made the same claims repeatedly in prior hearings on the bill in the Assembly.

However, as CNMHC Executive Director Sally Zinman pointed out in her opposing comments, neither Los Angeles nor any other county has ever implemented the law. The L.A. County pilot program in question is a jail diversion program for mental health clients charged with misdemeanors, and both the program director and the county have publicly stated that this program does not implement AB 1421, following a settlement of a lawsuit against the county in which the CNMHC was lead plaintiff. And none of the other counties mentioned has either approved or reviewed an RFP for any AB 1421 program.

Visibly piqued by Hagar's apparent misrepresentation of the facts to the Senate Committee, Ortiz rebuked Hagar, imploring him to be truthful in his statements to the committee.

Chesbro ups the ante.

Senator Wesley Chesbro (D-Arcata) argued forcefully against the bill, noting that in his years of consulting with consumers, survivors and advocates on mental health legislation, clients and survivors have consistently voiced opposition to a series of forced treatment bills, including AB 2357 and its predecessor, AB 1421, on the basis that people who have been subjected to involuntary treatment report having been traumatized by that experience and losing trust in the mental health system, often subsequently avoiding all services, and that clients/survivors view the expansion of involuntary treatment as a violation of their civil rights. Chesbro stated that with many new voluntary Mental Health Services Act (MHSA) services just now receiving funding, he saw any extension of involuntary treatment legislation beyond the sunset date as being at best premature; clients should first be given an opportunity to access new, voluntary services.

Ortiz moves to shorten the sunset date extension.

Ortiz echoed Chesbro's opposition to the bill, stating that she could not see why the involuntary outpatient commitment demonstration project for which the law provides should be extended to 2013, and that she too was was concerned that the bill would pre-empt the introduction of new voluntary services under the MHSA. She asked the AB 2357 co-authors present, Assemblymembers Betty Karnette (D-Long Beach), Leland Yee (D-San Francisco) and Senator Aanestad, whether they would consider amending the bill to shorten the extension to three years instead – to 2011.

Instead, the co-authors defended the legislation in its current form; Yee spoke of his twelve years as a psychologist in a San Francisco day treatment center for youth, recalling that he "had to" repeatedly invoke Welfare and Institutions Code Section 5150 to initiate an involuntary 72-hour psychiatric hold (under the Lanterman-Petris-Short (LPS) Act) in order to treat a number of young people diagnosed with mental illnesses whom he described as "non-compliant" and "unwilling to show up for day treatment". Yee claimed that court-ordered outpatient commitment legislation was needed as an additional tool to enforce compliance among treatment-resistant clients.

The million-dollar question: Prop 63 funding.

Ortiz raised the question of whether monies from the MHSA could be used to fund an AB 1421 program; Chesbro argued that the intent of the MHSA was to fund voluntary services, and that this intent was reflected in the DMH position in its MHSA Community Services and Supports Requirements that all services funded under the Act be "voluntary in nature".

Ortiz then asked the AB 2357 co-authors present whether they would accept an amendment to the bill to prohibit MHSA funding of such programs.

Rather than respond, proponents stood by as Aanestad made the rounds and counted likely "aye" votes among Committee members present.

Client advocate Dave Hosseini of the California Association of Social Rehabilitation Agencies (CASRA), who spoke in opposition at the hearing, later commented that the co-authors' silence in response to this proposed amendment offered evidence that they intend to seek MHSA funds for AB 1421/2357 programs.

Protection & Advocacy, Inc. (PAI) attorney Daniel Brzovic agrees, but points out that such funding is already prohibited under the MHSA. Brzovic, who also spoke briefly in opposition, has issued a public memorandum and co-authored an open letter to the DMH arguing that MHSA funds cannot be used to fund involuntary programs under AB 1421.

Advocate and PAI Board Director Sylvia Caras said that although she agrees that the MHSA cannot be used to directly fund AB 1421 programs, no one should be surprised if after counties receive funding for voluntary services under the MHSA, many then use other state funding once earmarked for voluntary services to fund involuntary outpatient commitment. For this reason, Caras did not support the MHSA prior to its passage.

New chamber, new trends.

This hearing departed from previous hearings on AB 2357 in the Assembly in a number of key ways. Whereas Democratic Assembly committee chairs Wilma Chan (D-Oakland), Dave Jones (D-Sacramento) and Judy Chu (D-Monterey Park) and Floor Leader Dario Frommer (D-Glendale) led the vast majority of Dems on their committees and on the Assembly Floor to join them in support of AB 2357, Ortiz and longtime mental health advocate Chesbro's vocal opposition emboldened fellow Dem Liz Figueroa (D-Fremont) on the Senate Health Committee to vote against the bill. Meanwhile, the Assembly trend of Republican-led opposition to the bill was also reversed, as recently added co-author Aanestad led the other three GOP senators on the Health Committee to vote "aye".

Playing it Kuehl.

Senator Sheila Kuehl (D-Los Angeles), who signed on as co-author of AB 2357 on June 7 along with Senators Aanestad, Scott (D-Pasadena) and Torlakson (D-Antioch), left the hearing just prior to this agenda item, and was not present for the discussion; she returned at the end for the vote, providing the crucial fifth "aye" vote to pass the bill out of the committee. Kuehl's conspicuous absence during the discussion was widely speculated to reflect her backing of a bill viewed by the majority of the committee's Democratic members as an affront to progressive mental health reform, despite Kuehl's reputation as a solid progressive on most issues.

What hasn't changed.

Consistent with past hearings, however, was the proponents' apparent ignorance of California's existing forced treatment laws. During discussion, co-author Aanestad stated that the LPS Act has been mainly used as a means of getting law enforcement on the scene in emergencies, and that extending Laura's Law was needed to reduce hospitalization, incarceration, and homelessness.

However, Brzovic points out that the LPS Act already provides for court-ordered temporary conservatorship for a person who is found by a psychiatrist to be "gravely disabled", i.e. unable to provide for themselves food, clothing and shelter. In response to an extreme and unusual act of violence by a mental health client, AB 1421 and the bill that would extend its sunset date merely duplicate existing law. And in the ensuing public battles, Brzovic notes, this redundant legislation has only added fuel to the fire of stigma and discrimination against mental health clients.